No medications are available that effectively treat patients suffering from anorexia nervosa, but a few behavioral therapies may help prevent a relapse and offer other limited benefits, according to a new review of currently available research on eating disorders released today by HHS’ Agency for Healthcare Research and Quality. The review also found evidence that several medications and behavioral therapies can help patients suffering from bulimia nervosa and binge eating disorder.
Eating disorders are psychiatric illnesses with serious, potentially life-threatening medical consequences. Anorexia nervosa is characterized by an obsession with weight, severely restrained eating, sometimes exercising excessively, and an inability to maintain a healthy body weight. In bulimia nervosa, excessive eating is followed by efforts to compensate by vomiting, misusing laxatives or diuretics, fasting, or exercising excessively. Those who suffer from binge eating disorder eat excessively but do not purge.
This review of the scientific literature published since 1980 was conducted by AHRQ’s Evidence-based Practice Center at RTI International and the University of North Carolina at Chapel Hill. It did not find any medications effective in treating anorexia nervosa but did find several behavioral therapies that appear to offer limited help. Cognitive behavioral therapy (CBT), a form of psychotherapy that encourages patients to develop thinking patterns that will counteract their unhealthy eating behavior, helped prevent relapse in adult anorexic patients once their weight had been restored to a normal level. There was not enough evidence to determine whether CBT works during the acute phase of the illness, before a patient with anorexia nervosa has been restored to a normal weight.
The researchers concluded that family therapy does not appear to work with adults with longstanding anorexia nervosa. One study found that family therapy worked better for younger patients than for older, more chronic patients. One particular kind of family therapy, which starts by encouraging parents to oversee a young person’s nutrition, appeared to help these patients gain weight and make psychological improvements.
Both medications and behavioral therapies were found helpful in treating bulimia nervosa; however, there was no clear information about how to combine medications with behavioral treatments.
The selective serotonin reuptake inhibitor (SSRI) fluoxetine, commonly known as Prozac, was found helpful in treating bulimia in a short-term clinical trial. Patients given a dose of 60 mg/day for 16 to 18 weeks had reduced symptoms and were less likely to experience a relapse by the end of 1 year. CBT, offered either individually or in a group, and interpersonal psychotherapy were also helpful in reducing the core symptoms of bulimia nervosa, binge eating and purging, and in alleviating the psychological symptoms of this disorder. However, the optimum length of treatment and the best strategy for maintaining these health benefits remain unknown.
Several types of medications helped patients suffering from binge eating disorder make at least short-term improvements to their health; these medications included SSRIs, tricyclic antidepressants, an anticonvulsant, and an appetite suppressant. CBT was also helpful in treating binge eating disorder, reducing the number of binge days or binge episodes patients experienced. It did not help patients with binge eating disorder control their weight.
“These findings underscore the need to learn more about the causes of these frightening and poorly understood illnesses and to find effective treatments,” said AHRQ Director Carolyn M. Clancy, M.D. “In the meantime, we need to make sure that clinicians use the evidence we currently have to help those suffering from eating disorders.”
The review concludes that more research is needed to determine the best strategies for combining medication and behavioral therapy, possible harms of treatment, and whether treatments should be tailored to a patient’s age, sex, gender, or other personal characteristics. A major gap in knowledge exists about how to treat patients with bulimia nervosa who do not respond either to fluoxetine or to CBT.
Though the numbers are difficult to establish, the National Eating Disorders Association estimates that about 10 million girls and women and about 1 million boys and men in the United States suffer from either anorexia nervosa or bulimia nervosa. As many as 25 million additional individuals may be affected by binge eating disorder. Although these disorders most commonly affect people in their teens and twenties, they are found in all age groups, even young children. Those who suffer from eating disorders can experience a wide range of physical health complications, including serious heart conditions and kidney failure. Only about half of patients who are diagnosed with anorexia nervosa and bulimia nervosa fully recover, and many individuals struggle for decades with these disorders.
Anorexia nervosa has particularly devastating medical and psychological consequences that can persist even after recovery. If it begins in the teenage years, it can interfere with normal adolescent development. Patients with anorexia nervosa often suffer as well from emotional problems such as depression, anxiety, social withdrawal, heightened self-consciousness, and fatigue. Treatment of anorexia nervosa is also quite costly, as the more serious cases often require hospitalization in specialized facilities. Data from AHRQ’s Healthcare Cost & Utilization Project show that in 2003 a typical 16½-day hospital stay for an anorexia nervosa patient resulted in charges of $30,970. Lack of insurance coverage can mean that such patients do not get the treatment they need.